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Impact of Obstructive Jaundice and Socioeconomic Determinants on Outcomes in Gallbladder Cancer: A Prospective Cohort
Kumar Vineet1, Mayank Tripathi2, Dhaval R Vadodaria2
1Department of Surgical Oncology, MPMMCC & HBCH, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, India. likho2vineet@gmail.com.
Purpose:
To assess how obstructive jaundice and socioeconomic determinants (residence, literacy, gender) affect treatment initiation and curative surgical eligibility among patients with gallbladder cancer in North India.
Methods:
In this prospective observational cohort, adults with radiological or histological gallbladder cancer presenting between September 2023 and May 2024 were enrolled at a tertiary cancer centre. Baseline demographics, stage, obstructive jaundice status, biliary drainage (PTBD/ERCP), treatment initiation, and surgical eligibility were recorded. Associations were examined using chi-square and relative risk, followed by multivariable logistic regression including variables with p < 0.10.
Results:
Of 1,500 enrolled patients, 1,409 were evaluable; 643 (45.6%) had obstructive jaundice. Treatment non-initiation occurred in 330/643 (51.3%) with obstructive jaundice versus 24/766 (3.1%) without obstructive jaundice (p < 0.001). Curative surgery was feasible in 51/643 (7.9%) with obstructive jaundice compared with 223/766 (29.1%) without obstructive jaundice (RR 0.27; 95% CI 0.20-0.36). Illiteracy (57.6%) and rural residence (69.4%) predominated. On multivariable analysis, independent predictors of treatment non-initiation were obstructive jaundice (aOR 11.2; 95% CI 7.6-16.5), metastatic disease at presentation (aOR 3.9; 95% CI 2.1-7.4), rural residence (aOR 2.7; 95% CI 1.9-3.9), and illiteracy (aOR 1.8; 95% CI 1.3-2.6).
Conclusion:
Obstructive jaundice and socioeconomic disadvantage synergistically drive early care discontinuity and reduce curative opportunities in gallbladder cancer, supporting decentralized decompression, patient navigation, and socioeconomic support in high-incidence regions.
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